<!DOCTYPE html>
<html>

<head>
    <meta charset="utf-8" />
    <meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=0, minimum-scale=1.0, maximum-scale=1.0">
    <meta name="format-detection" content="telephone=no" />
    <link rel="stylesheet" href="css/reset.css" />
    <link rel="stylesheet" type="text/css" href="css/css.css" />
    <!--<script src="https://code.jquery.com/jquery-3.1.1.min.js"></script>-->
    <script type="text/javascript" src="/js/jquery-3.4.1.min.js"></script>
    <script type="text/javascript" src="js/rem.js"></script>
    <title>问卷调查</title>
    <style>

    </style>
</head>

<body>
<div class="page_body">
    <div class="input_form">
        <div class="main_box">
            <div class="input_item">
                <div class="input_item_tit">
                    <div class="item_tit_num">1</div>
                    <div class="item_tit_txt">基本信息</div>
                </div>
                <form action="" method="post" id="form1">
                    <div class="input_item_cont">
                        <div class="item_cont_line">
                            <div class="item_cont_name">姓名</div>
                            <input class="item_form_input" type="text" name="name" placeholder="请输入姓名" />
                        </div>
                        <div class="item_cont_line">
                            <div class="item_cont_name">性别</div>
                            <div class="item_cont_radio">
                                <label class="ww">
                                    <div class="cont_radio_div on">
                                        <input class="item_form_radio" id="item1" type="radio" name="gender" value="1" checked><label></label>
                                        <span class="radio_name">男</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div on">
                                        <input class="item_form_radio" id="item2" type="radio" name="gender" value="2"><label></label>
                                        <span class="radio_name">女</span>
                                    </div>
                                </label>
                            </div>
                        </div>
                        <div class="item_cont_line">
                            <div class="item_cont_name">年龄</div>
                            <input class="item_form_input" type="text" name="age" placeholder="请输入年龄" />
                        </div>
                        <!-- <div class="item_cont_line">
                             <div class="item_cont_name">单位</div>
                             <div class="item_cont_radio">
                                 <select name="company" class="item_form_select">
                                     <option value="" class="item_form_option">请选择</option>
                                     <option value="银川分公司" class="item_form_option">银川分公司</option>
                                     <option value="吴忠分公司" class="item_form_option">吴忠分公司</option>
                                     <option value="石嘴山分公司" class="item_form_option">石嘴山分公司</option>
                                     <option value="中卫分公司" class="item_form_option">中卫分公司</option>
                                     <option value="固原分公司" class="item_form_option">固原分公司</option>
                                     <option value="直属单位" class="item_form_option">直属单位</option>
                                     <option value="机关本部" class="item_form_option">机关本部</option>
                                 </select>
                             </div>
                         </div>-->
                        <div class="item_cont_line">
                            <div class="item_cont_name">手机号</div>
                            <input class="item_form_input" id="s" type="text" name="phone" placeholder="请输入电信手机号" />
                        </div>
                        <!--<div class="item_cont_line" style="display: flex;align-items: center;">
                            <input style="text-align: left;" class="item_form_input" type="text" name="yzm" id="z" placeholder="请输入验证码">
                            <div class="page_bottom_btn" id="yzm" onclick="settime(this)">获取验证码</div>
                        </div>-->
                        <div class="item_cont_line">
                            <div class="item_cont_name">单位</div>
                            <div class="item_cont_radio">
                                <select name="cars" id="select" class="item_form_select">
                                    <option value="0" class="item_form_option">请选择</option>
                                    <option value="直属单位" class="item_form_option">直属单位</option>
                                    <option value="银川分公司" class="item_form_option">银川分公司</option>
                                    <option value="吴忠分公司" class="item_form_option">吴忠分公司</option>
                                    <option value="固原分公司" class="item_form_option">固原分公司</option>
                                    <option value="中卫分公司" class="item_form_option">中卫分公司</option>
                                    <option value="石嘴山分公司" class="item_form_option">石嘴山分公司</option>
                                    <option value="区公司本部" class="item_form_option">区公司本部</option>
                                </select>
                                <select name="company" id="val" class="item_form_select">
                                    <option value="0" class="item_form_option">请选择</option>
                                </select>
                            </div>
                        </div>
                        <div class="item_cont_line">
                            <div class="item_cont_name"></div>
                            <div class="item_cont_radio">

                            </div>
                        </div>
                    </div>
                </form>
            </div>
            <div class="input_item">
                <div class="input_item_tit">
                    <div class="item_tit_num">2</div>
                    <div class="item_tit_txt">一般情况</div>
                </div>
                <form action="" method="post" id="form2">
                    <div class="input_item_cont">
                        <div class="item_cont_line">
                            <div class="item_cont_name">身高（m）</div>
                            <input class="item_form_input" type="text" id="my_height" name="height" oninput="myHeight()" placeholder="请输入身高">
                        </div>
                        <div class="item_cont_line">
                            <div class="item_cont_name">体重（kg）</div>
                            <input class="item_form_input" type="text" id="my_weight" name="weight" oninput="myWeight()" placeholder="请输入体重">
                        </div>
                        <div class="item_cont_line">
                            <div class="item_cont_name">腰围</div>
                            <input class="item_form_input" type="text" name="yaowei" placeholder="请输入腰围" />
                        </div>
                        <div class="item_cont_line">
                            <div class="item_cont_name">体重指数（BMI）</div>
                            <span class="radio_name" id="my_bmi"></span>
                            <input style="display: none" type="text" class="my_bmi" value="" name="my_bmi" />
                            <span class="radio_name">kg/㎡</span>
                        </div>
                    </div>
                </form>
                <div class="">
                    <form action="" method="post" id="form3">
                        <div class="item_cont_line_2">
                            <div class="item_cont_name">父亲有无家族史</div>
                            <div class="item_cont_radio">
                                <label class="ww">
                                    <div class="cont_radio_div on">
                                        <input class="item_form_radio" id="f_ill_yse" type="radio" onclick="fatherIllNo()" name="f_ill" value="0" checked><label></label>
                                        <span class="radio_name">无</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div on">
                                        <input class="item_form_radio" id="f_ill_no" type="radio" onclick="fatherIllYse()" name="f_ill" value="1"><label></label>
                                        <span class="radio_name">有</span>
                                    </div>
                                </label>
                            </div>
                        </div>
                    </form>
                    <form action="" method="post" id="form4">
                        <div id="father_ill" style="display: none;">
                            <div class="item_cont_radio" style="margin-left: .42rem;display: flex;justify-content: space-between;">
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="father_gxy" value="1"><label></label>
                                        <span class="radio_name">高血压</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="father_tnb" value="1"><label></label>
                                        <span class="radio_name">糖尿病</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="father_zyb" value="1"><label></label>
                                        <span class="radio_name">职业病</span>
                                    </div>
                                </label>
                            </div>
                            <div style="margin-left: .9rem;font-size: 12px;border-bottom: 1px solid #DAD8D8;">
                                <span class="radio_name">其他</span>
                                <input class="item_form_input" style="text-align: left;" type="text" name="father_qt" />
                            </div>
                        </div>
                    </form>
                </div>
                <div class="">
                    <form action="" method="post" id="form5">
                        <div class="item_cont_line_2">
                            <div class="item_cont_name">母亲有无家族史</div>
                            <div class="item_cont_radio">
                                <label class="ww">
                                    <div class="cont_radio_div on">
                                        <input class="item_form_radio" id="m_ill_yse" type="radio" onclick="motherIllNo()" name="m_ill" value="0" checked><label></label>
                                        <span class="radio_name">无</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div on">
                                        <input class="item_form_radio" id="m_ill_no" type="radio" onclick="motherIllYse()" name="m_ill" value="1"><label></label>
                                        <span class="radio_name">有</span>
                                    </div>
                                </label>
                            </div>
                        </div>
                    </form>
                    <form action="" method="post" id="form6">
                        <div id="mother_ill" style="display: none;">
                            <div class="item_cont_radio" style="margin-left: .42rem;display: flex;justify-content: space-between;">
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="mother_gxy" value="1"><label></label>
                                        <span class="radio_name">高血压</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="mother_tnb" value="1"><label></label>
                                        <span class="radio_name">糖尿病</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="mother_zyb" value="1"><label></label>
                                        <span class="radio_name">职业病</span>
                                    </div>
                                </label>
                            </div>
                            <div style="margin-left: .9rem;font-size: 12px;border-bottom: 1px solid #DAD8D8;">
                                <span class="radio_name">其他</span>
                                <input class="item_form_input" style="text-align: left;" type="text" name="mother_qt" />
                            </div>
                        </div>
                    </form>
                </div>
            </div>
            <div class="input_item">
                <div class="input_item_tit">
                    <div class="item_tit_num">3</div>
                    <div class="item_tit_txt">现存主要健康问题</div>
                </div>
                <form action="" method="post" id="form7">
                    <div class="item_cont_line_2">
                        <div class="item_cont_name_2">现存主要健康问题</div>
                        <div class="item_cont_radio">
                            <label class="ww">
                                <div class="cont_radio_div on">
                                    <input class="item_form_radio" id="n_ill_yse" type="radio" onclick="healthProblemNo()" name="h_problem" value="0" checked><label></label>
                                    <span class="radio_name">无</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div on">
                                    <input class="item_form_radio" id="n_ill_no" type="radio" onclick="healthProblemYse()" name="h_problem" value="1"><label></label>
                                    <span class="radio_name">有</span>
                                </div>
                            </label>
                        </div>
                    </div>
                </form>
                <div class="wws" id="health_problem" style="display: none;">
                    <form action="" method="post" id="form8">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_gxy" value="1"><label></label>
                                    <span class="radio_name">高血压</span>
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_gxy_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_gxy_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                    </form>

                    <form action="" method="post" id="form9">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_tnb" value="1"><label></label>
                                    <span class="radio_name">糖尿病</span>
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_tnb_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_tnb_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                    </form>

                    <form action="" method="post" id="form10">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_gxb" value="1"><label></label>
                                    <span class="radio_name">冠心病</span>
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_gxb_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_gxb_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                    </form>

                    <form action="" method="post" id="form11">
                        <div class="" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_mxzsx" value="1"><label></label>
                                    <span class="radio_name">慢性阻塞性疾病</span>
                                </div>
                            </label>
                            <div class="item_cont_radio">
                                <div class="cont_radio_div">
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="radio" name="health_mxzsx_yy" value="1"><label></label>
                                        <span class="radio_name">是</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="radio" name="health_mxzsx_yy" value="0"><label></label>
                                        <span class="radio_name">否</span>
                                    </div>
                                </label>
                            </div>
                        </div>
                    </form>

                    <form action="" method="post" id="form12">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_exzl" value="1"><label></label>
                                    <span class="radio_name">恶性肿瘤</span>
                                    <span class="radio_name_txt" style="margin-left: 22px;">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_exzl_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_exzl_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                    </form>

                    <form action="" method="post" id="form13">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_ncz" value="1"><label></label>
                                    <span class="radio_name">脑卒中</span>
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_ncz_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_ncz_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                    </form>

                    <form action="" method="post" id="form14">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_zyb" value="1"><label></label>
                                    <span class="radio_name">职业病</span>
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_zyb_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_zyb_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                    </form>

                    <form action="" method="post" id="form15">
                        <div class="" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_yjp" value="1"><label></label>
                                    <span class="radio_name">腰(椎)间盘突出</span>
                                </div>
                            </label>
                            <div class="item_cont_radio">
                                <div class="cont_radio_div">
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="radio" name="health_yjp_yy" value="1"><label></label>
                                        <span class="radio_name">是</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="radio" name="health_yjp_yy" value="0"><label></label>
                                        <span class="radio_name">否</span>
                                    </div>
                                </label>
                            </div>
                        </div>
                    </form>

                    <form action="" method="post" id="form16">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_jzb" value="1"><label></label>
                                    <span class="radio_name">颈椎病</span>
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_jzb_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_jzb_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                    </form>

                    <form action="" method="post" id="form17">
                        <div class="" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_gnsxz" value="1"><label></label>
                                    <span class="radio_name">高尿酸血症</span>
                                </div>
                            </label>
                            <div class="item_cont_radio">
                                <div class="cont_radio_div">
                                    <span class="radio_name_txt">用药情况</span>
                                </div>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="radio" name="health_gnsxz_yy" value="1"><label></label>
                                        <span class="radio_name">是</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="radio" name="health_gnsxz_yy" value="0"><label></label>
                                        <span class="radio_name">否</span>
                                    </div>
                                </label>
                            </div>
                        </div>
                    </form>

                    <form action="" method="post" id="form18">
                        <div class="item_cont_radio" style="margin-left: .42rem;">
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="checkbox" name="health_gxzz" value="1"><label></label>
                                    <span class="radio_name">高血脂症</span>
                                    <span class="radio_name_txt" style="margin-left: 22px;">用药情况</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_gxzz_yy" value="1"><label></label>
                                    <span class="radio_name">是</span>
                                </div>
                            </label>
                            <label class="ww">
                                <div class="cont_radio_div">
                                    <input class="item_form_radio" type="radio" name="health_gxzz_yy" value="0"><label></label>
                                    <span class="radio_name">否</span>
                                </div>
                            </label>
                        </div>
                        <div style="margin-left: .9rem;font-size: 12px;border-bottom: 1px solid #DAD8D8;">
                            <span class="radio_name">其他</span>
                            <input class="item_form_input" style="text-align: left;" type="text" name="health_qita" />
                        </div>
                    </form>
                </div>
            </div>
            <div class="input_item ons">
                <div class="input_item_tit">
                    <div class="item_tit_num">4</div>
                    <div class="item_tit_txt">生活方式</div>
                </div>
                <form action="" method="post" id="form19">
                    <div class="input_item_cont">
                        <div class="item_tit_txt_2">Q1：体育锻炼频率（单选）</div>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="tydlpl" value="1"><label></label>
                                <span class="radio_name">每天</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="tydlpl" value="2"><label></label>
                                <span class="radio_name">每周一次以上</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="tydlpl" value="3"><label></label>
                                <span class="radio_name">偶尔</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="tydlpl" value="4"><label></label>
                                <span class="radio_name">不锻炼</span>
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                        </label>
                    </div>
                </form>
                <form action="" method="post" id="form20">
                    <div class="input_item_cont">
                        <div class="item_tit_txt_2">Q2：饮食习惯（多选）</div>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="ysxg[]" value="1"><label></label>
                                <span class="radio_name">荤素均衡</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="ysxg[]" value="2"><label></label>
                                <span class="radio_name">荤食为主</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="ysxg[]" value="3"><label></label>
                                <span class="radio_name">素食为主</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="ysxg[]" value="4"><label></label>
                                <span class="radio_name">嗜盐</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="ysxg[]" value="5"><label></label>
                                <span class="radio_name">嗜油</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="ysxg[]" value="6"><label></label>
                                <span class="radio_name">嗜糖</span>
                            </div>
                        </label>
                    </div>
                </form>
                <form action="" method="post" id="form21">
                    <div class="input_item_cont">
                        <div class="item_tit_txt_2">Q3：吸烟情况（单选）</div>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="xyqk" value="1"><label></label>
                                <span class="radio_name">每天从不吸烟</span>
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                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="xyqk" value="2"><label></label>
                                <span class="radio_name">已戒烟</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="xyqk" value="3"><label></label>
                                <span class="radio_name">吸烟</span>
                            </div>
                        </label>
                    </div>
                </form>
                <form action="" method="post" id="form22">
                    <div class="input_item_cont">
                        <div class="item_tit_txt_2">Q4：饮酒频率（单选）</div>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="yjpl" value="1"><label></label>
                                <span class="radio_name">从不</span>
                            </div>
                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="yjpl" value="2"><label></label>
                                <span class="radio_name">偶尔</span>
                            </div>
                        </label>
                        <label class="ww">
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                                <input class="item_form_radio" type="radio" name="yjpl" value="3"><label></label>
                                <span class="radio_name">经常</span>
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                        </label>
                        <label class="ww">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="yjpl" value="4"><label></label>
                                <span class="radio_name">每天</span>
                            </div>
                        </label>
                    </div>
                </form>
            </div>
            <div class="input_item">
                <div class="input_item_tit">
                    <div class="item_tit_num">5</div>
                    <div class="item_tit_txt">您对健康管理的诉求是：</div>
                </div>
                <div class="">
                    <form action="" method="post" id="form23">
                        <div id="mother_ill">
                            <div class="item_cont_radio" style="margin-left: .42rem;display: flex;justify-content: space-between;">
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="kpjz" value="1"><label></label>
                                        <span class="radio_name">科普讲座</span>
                                    </div>
                                </label>
                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="jnpx" value="1"><label></label>
                                        <span class="radio_name">技能培训</span>
                                    </div>
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                                <label class="ww">
                                    <div class="cont_radio_div">
                                        <input class="item_form_radio" type="checkbox" name="xz" value="1"><label></label>
                                        <span class="radio_name">巡诊</span>
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                                </label>
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                            <div style="margin-left: .9rem;font-size: 12px;border-bottom: 1px solid #DAD8D8;">
                                <span class="radio_name">其他</span>
                                <input class="item_form_input" style="text-align: left;" type="text" name="jkgl_qita" />
                            </div>
                        </div>
                    </form>
                </div>
            </div>
            <div class="page_bottom">
                <div class="page_bottom_txt">到底啦！非常感谢您的参与！</div>
                <div class="page_bottom_btns" onclick="replacePage()">提交问卷</div>
            </div>
        </div>
    </div>
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